Racially Diverse ZIP Codes See Disparities in MAT Access

ZIP codes with more racial and ethnic diversity have markedly fewer buprenorphine prescribers and far lower rates of dispensed buprenorphine prescriptions, according to researchers from the University of Pittsburgh School of Public Health, showing a severe racial and ethnic health disparity in patient access to substance use disorder treatment.

The study, published recently in the Journal of Addiction Medicine, did use pre-pandemic data, but the researchers said it still outlines a problem with the SUD workforce.

Buprenorphine, one of the key drugs in medication assisted treatment (MAT), is the gold standard for treating SUD. But as the United States continues to stare down an opioid overdose epidemic that disproportionately affects racial and ethnic minority groups, the Pitt Public Health researchers sought to understand patient access based on geography and racial composition.

Using 2018 IQVIA prescription data, IQVIA OneKey data, and Microsoft Bing Maps, the researchers tallied the number of providers authorized to prescribe buprenorphine per 1,000 residents within a 30-minute drive of a ZIP code. They also calculated the number of buprenorphine prescriptions dispensed per capita at retail pharmacies among nearby authorized prescribers.

From there, they compared differences by the racial and ethnic composition of ZIP codes.

Overall, the researchers estimated that it would be harder for a person in a more racially and ethnically diverse ZIP code to access buprenorphine, both due to prescriber shortages and lower prescription rates among existing prescribers.

“The degree is rather striking,” according to Coleman Drake, PhD, the study’s lead author and an assistant professor in the Department of Health Policy and Management at Pitt Public Health.

“Access is substantially better in areas that are very white,” Coleman noted. “When you move to areas with even some racial or ethnic diversity, there is a large decline in the geographic availability of buprenorphine prescribers and prescription fills. In areas that are less than 95 percent white, for example, there’s a 45 to 50 percent drop.”

More specifically, Coleman and colleagues found that in more ethnically and racially diverse urban ZIP codes, there were between 45 and 55 fewer buprenorphine prescribers; in more diverse rural ZIP codes, there were between 62 and 79 percent fewer prescribers.

This trend persisted when looking at dispensed buprenorphine prescriptions. In diverse urban ZIP codes, there were between 51 and 76 percent fewer dispensed prescriptions, and in diverse rural areas, there were between 68 and 87 percent fewer dispensed prescriptions.

Healthcare policymakers can begin addressing these disparities by looking at the number of providers authorized to prescribe buprenorphine.

Currently, prescribers no longer face a federal requirement for an “X” waiver to prescribe buprenorphine, and all providers who have a current DEA registration including Schedule III authority can now prescribe buprenorphine for OUD if permitted by state law, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

This flexibility was enacted in 2023 to increase the number of providers authorized to prescribe buprenorphine as part of MAT, but the Pitt study looked at 2018 data. Coleman and colleagues suggested further study into how these recent changes, plus telehealth flexibilities, have impacted racial and geographic disparities in MAT access.

Some data suggests that regulation changes have had a limited impact on MAT access. In 2023, a research letter in JAMA Network showed that 2020 policies allowing buprenorphine access via telehealth and 2021 policies eliminating mandated, eight-hour federal education for prescribers had little impact on patient care access.

Coleman and colleagues suggested a further look into barriers to prescribing for already-authorized providers could be helpful.

Other data have shown that authorized prescribers don’t always write the maximum number of prescriptions allowed, which could contribute to care access gaps. Better provider education to increase provider confidence could encourage them to prescribe MAT to all patients who need and qualify for the treatment.